Fierce Healthcare

NOVEMBER 25, 2024

UnitedHealthcare successfully won its lawsuit over the Centers for Medicare and Medicaid Services, a federal judge determined Nov. UnitedHealthcare will get to claim victory over CMS for its star ratings lawsuit win.

Medicaid 119

Medicaid Medicaid Medicare Medicare 119

Healthcare Dive

SEPTEMBER 9, 2024

The insurer’s Wellpoint subsidiary is expanding its ACA footprint for the 2025 coverage year, likely in a bid to capture enrollees who recently lost Medicaid coverage.

ACA 147

ACA Medicaid Medicaid 147

Fierce Healthcare

SEPTEMBER 27, 2024

Medicare's open enrollment window opens in a few weeks, and the Centers for Medicare & Medicaid Services is offering a broad look at the landscape around Medicare Advantage and Part D before si | Medicare's open enrollment window opens in a few weeks, and the Centers for Medicare & Medicaid Services is offering a broad look at the (..)

Medicare 121

Medicare Medicare Medicaid Medicaid 121

Fierce Healthcare

APRIL 1, 2024

Insurers will feel resentful Monday as the feds opted to not reverse its decision to decrease Medicare Advantage benchmark payments by 0.16%, the Centers for Medicare and Medicaid announced. | Benchmark payments will still decrease 0.16% but the feds expect it will still pay up to $600 billion in payments to plans in 2025.

Medicare 143

Medicare Medicare Medicaid Medicaid 143

Fierce Healthcare

OCTOBER 21, 2024

Humana, one the country’s largest Medicare Advantage organizations, is suing the Centers for Medicare & Medicaid Services over its 2025 star | Humana, one the country’s largest Medicare Advantage organizations, is suing the Centers for Medicare & Medicaid Services over its 2025 star ratings results.

Medicaid 116

Medicaid Medicaid Medicare Medicare 116

Fierce Healthcare

NOVEMBER 4, 2024

Days before the 2024 presidential election, the Centers for Medicare & Medicaid Services (CMS) released an unpublished version of the final calendar year 2025 physician fee schedule final rule | Digital therapeutics, telehealth, rural heath clinics and opioid treatment programs all got updates in the final 2025 Medicare physician fee schedule rule, (..)

Medicare 127

Medicare Medicare Medicaid Medicaid 127

Fierce Healthcare

JULY 11, 2024

The Centers for Medicare & Medicaid Services' (CMS') proposed calendar year 2025 physician fee schedule rule, out Wednesday, proposed an assortment of new payments and coverage for digital heal | CMS' proposed changes to digital health payment for physicians includes new codes for mental health-related digital therapeutics, an assortment (..)

Medicaid 129

Medicaid Medicaid Medicare Medicare 129

Fierce Healthcare

JULY 10, 2024

A proposed rule outlining the Centers for Medicare & Medicaid Services’ (CMS’) intended Medicare payment rates and policy updates for outpatient and ambulatory surgical centers (ASCs) in the co | The administration's CY 2025 OPPS and ASC Payment Systems proposed rule looks to improve obstetrical services, quality reporting and care access. (..)

Payment Systems 124

Payment Systems Medicare Medicare Medicaid 124

Fierce Healthcare

DECEMBER 17, 2024

The Centers for Medicare & Medicaid Services (CMS) is discontinuing the Medicare Advantage (MA) Value-Based Insurance Design model at the end of 2025. | The Value-Based Insurance Design model for Medicare Advantage plans will be terminated at the end of next year.

Medicare 90

Medicare Medicare Medicaid Medicaid 90

Fierce Healthcare

APRIL 2, 2024

States now can add routine adult dental services as an essential health benefit, the Centers for Medicare & Medicaid Services announced in its 2025 Notice of Benefit and Payment Parameters fina | In its annual Notice of Benefit and Payment Parameters final rule, CMS prioritized dental and prescription drug benefits, network adequacy standardization (..)

ACA 110

ACA Medicaid Medicaid Medicare 110

HIT Consultant

NOVEMBER 22, 2024

Key recommendations include: Extend Enhanced Tax Credits: Make permanent the enhanced marketplace premium tax credits, which are set to expire in 2025, to prevent premium increases and coverage losses. Expand Medicaid: Establish a federal fallback option to cover the millions of uninsured individuals in states that have not expanded Medicaid.

ACA 98

ACA Health Insurance Medicaid Medicaid 98

HIT Consultant

DECEMBER 11, 2024

Food as Medicine: This trend has emerged from its niche, driven by increased funding and partnerships, particularly within Medicare Advantage and Medicaid programs. Looking Ahead to 2025 The digital health landscape is constantly evolving.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

HIT Consultant

JULY 18, 2024

– In accordance with the AMA semi-annual early release schedule, the new codes will be effective January 1st, 2025 and published in the 2025 CPT Code book. CPT Codes: CPT codes are essential for healthcare reimbursement, used by government payers such as Medicare and Medicaid, as well as commercial insurance companies.

FDA 114

FDA Medicaid Medicaid Medicare 114

Innovaare Compliance

APRIL 7, 2024

The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025 – average increase of 3.7% or $16 billion in 2025 over 2024 in expected MA payments. generics) beginning in 2025 [1].

Medicare 59

Medicare Medicare COVID-19 Medicaid 59

Fierce Healthcare

AUGUST 21, 2023

The Centers for Medicare & Medicaid Services (CMS) released new draft guidance Monday on how it plans to roll out a program that allows Medicare members to spread out monthly payments for presc | New draft guidance gives a blueprint for pharmacies to begin offering monthly payments on prescription drugs starting in 2025.

Medicare 98

Medicare Medicare Medicaid Medicaid 98

Healthcare IT News - Telehealth

APRIL 9, 2019

Centers for Medicare and Medicaid Services Administrator Seema Verma has called for expansion of reimbursement for remote care, with CMS seeking to "make sure home health agencies can leverage innovation to provide state-of-the-art care ," she said. " Twitter: @MikeMiliardHITN. Email the writer: mike.miliard@himssmedia.com.

Hospitals 166

Hospitals Medicaid Medicaid Medicare 166

Jane Sarashon

JULY 18, 2024

Following the BLS report on the CPI for June 2024, PwC published their new annual report from PwC titled Behind the Numbers 2025 tells us that commercial health care spending is expected to grow some 8.0% (Motor vehicle insurance costs grew a whopping 19.5% in the report, FYI). for Group plans and 7.5% and 7.0%, respectively.

Doctors 59

Doctors Prescription Drug Pricing Hospitals Health Insurance 59

Innovaare Compliance

FEBRUARY 25, 2024

The Centers for Medicare & Medicaid Services (CMS) uses the Hierarchical Condition Category (CMS-HCC) medicare risk adjustment model to determine monthly capitation fees for Medicare Advantage (MA) plans. The coverage gap will be eliminated in 2025, and manufacturers’ discounts will begin in ICL. PDT on June 3, 2024.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Innovaare Compliance

APRIL 7, 2024

The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025 – average increase of 3.7% or $16 billion in 2025 over 2024 in expected MA payments. generics) beginning in 2025 [1].

Medicare 52

Medicare Medicare COVID-19 Medicaid 52

Provider Trust

NOVEMBER 20, 2024

The National Committee for Quality Assurance (NCQA) has released updated standards for credentialing processes among payers for 2025. Though these guidelines take effect on July 1, 2025, payers must act now to ensure they can ramp up their credentialing processes appropriately.

Licensing 52

Licensing Compliance Medicaid Medicaid 52

Health Care Law Brief

FEBRUARY 2, 2024

On Tuesday, January 16, 2024, Governor Kathy Hochul released the SFY 2025 New York State Executive Budget (“Executive Budget”). While still subject to legislative approval, the Executive Budget incorporates the recently approved amendment (“Waiver Amendment”) to New York’s Medicaid Section 1115 Demonstration that includes $7.5

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Innovaare Compliance

FEBRUARY 19, 2024

On January 31, 2024, the Centers for Medicare & Medicaid Services (CMS) released a draft of the 2025 Advance Notice describing the Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ahead of the final notice to be published on April 1, 2024.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Innovaare Compliance

FEBRUARY 19, 2024

On January 31, 2024, the Centers for Medicare & Medicaid Services (CMS) released a draft of the 2025 Advance Notice describing the Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ahead of the final notice to be published on April 1, 2024.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

HIT Consultant

JULY 15, 2024

– The Centers for Medicare & Medicaid Services (CMS) released a proposed rule outlining changes to Medicare payments under the Physician Fee Schedule (PFS) for services furnished and other Medicare Part B issues on or after January 1, 2025.

Medicare 52

Medicare Medicare Payment Systems Medicaid 52

Natalia Mazina

OCTOBER 30, 2022

The Act – at its core – gives CMS ability to negotiate drug prices for Medicare and Medicaid plans. I will only focus on what the Act has in store for pharmacies and will highlight the most important provisions for the pharmacy industry. By 2026, CMS will directly negotiate prices for selected drugs (initially the 10 most expensive drugs ).

Medicare 98

Medicare Medicare Medicaid Medicaid 98

Innovaare Compliance

APRIL 6, 2024

The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025 – average increase of 3.7% or $16 billion in 2025 over 2024 in expected MA payments. generics) beginning in 2025 [1].

Medicare 52

Medicare Medicare COVID-19 Medicaid 52

Innovaare Compliance

JUNE 30, 2024

The Centers for Medicare & Medicaid Services (CMS) provides standardized model materials to facilitate the process. Notable changes related to Part D Re-design and regulations in the final rule are highlighted below: Part D Coverage Gap is removed in CY 2025, as all references should be (e.g., Section 2.1 and Section 3.2,

Medicare 52

Medicare Medicare Compliance Medicaid 52

Healthcare IT News - Telehealth

AUGUST 29, 2024

The American Telemedicine Association and ATA Action in a letter to the Centers for Medicare and Medicaid Services seeks to preserve pandemic-era Medicare telehealth flexibilities that it says are responsible for improving access to healthcare across the U.S. Email: afox@himss.org Healthcare IT News is a HIMSS Media publication.

Medicare 122

Medicare Medicare Medicaid Medicaid 122

Health Care Law Brief

FEBRUARY 8, 2024

This year’s Health and Mental Hygiene Bill (“HMH Bill”) (part of the Governor’s FY 2025 Executive Budget) proposes a $233 billion balanced budget, which includes $35.5 billion to fund Medicaid, $4.8 The Department of Health (“DOH”) would establish Medicaid reimbursement rates for such off-site services.

Medicaid 52

Medicaid Medicaid Nurses Licensing 52

Hall Render

AUGUST 27, 2024

The Centers for Medicare & Medicaid Services (“CMS”) will publish the 2025 Inpatient Prospective Payment System (“IPPS”) Final Rule (“Final Rule”) in the Federal Register on August 28 with an effective date of October 1, 2024. In FY 2025, acute care hospitals are estimated to experience a $3.2 for a total increase of 2.9%.

Hospitals 40

Hospitals Payment Systems Medicare Medicare 40

Healthcare IT News - Telehealth

SEPTEMBER 15, 2021

Research firm Frost & Sullivan forecasts a sevenfold growth in telehealth by 2025 – a five-year compound annual growth rate of 38%. The Centers for Medicare and Medicaid Services (CMS) began to allow for reimbursement for videoconferencing between healthcare provider and patient.

Telemedicine 192

Telemedicine COVID-19 Medicare Medicare 192

Bill of Health

OCTOBER 17, 2024

This aligns with recent guidance from the Centers for Medicare and Medicaid Services that Medicare Advantage plans may not make a determination of medical necessity solely based on algorithms using broad data sets. 2025) research interests are focused on the intersection of health and the law. Rebekah Ninan’s (J.D.

Medicare 150

Medicare Medicare Health Insurance Licensing 150

Innovaare Compliance

JUNE 17, 2024

The Centers for Medicare & Medicaid Services (CMS) provides standardized model materials to facilitate the process. Notable changes related to Part D Re-design and regulations in the final rule are highlighted below: Part D Coverage Gap is removed in CY 2025, as all references should be (e.g., CMS Final Rule 4205 F for CY 2025

Medicare 40

Medicare Medicare Compliance Medicaid 40

Hall Render

SEPTEMBER 10, 2024

On July 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) issued its calendar year 2025 Medicare Physician Fee Schedule (“MPFS”) proposed rule (“Proposed Rule”), to implement certain payment updates effective January 1, 2025.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Center for Health Insurance Reform

MAY 15, 2024

The Centers for Medicare & Medicaid Services have recently finalized rules and standards governing health plans and Marketplaces under the Affordable Care Act.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Healthcare IT Today

APRIL 24, 2023

In a few years, MedArrive has built an impressive list of customers – especially with managed Medicaid health plans – demonstrating a significant ability to improve the health of very at-risk populations while also lowering costs.

Medicaid 105

Medicaid Medicaid Health Insurance Telemedicine 105

HIT Consultant

DECEMBER 12, 2024

Erin Crum, Sr.

Payment Systems 52

Payment Systems Medicaid Medicaid Medicare 52